166 finals

prostaglandin E(1 and 2) (dinoprostone/cervidil) and (misoprostol) route

po or vaginally

prostaglandin E(1 and 2) (dinoprostone/cervidil) and (misoprostol) action

More effective at achieving vaginal delivery within 24hrs

what to monitor the mother on after taking prostaglandin

signs of uterine tachysystole and fetal heart rate abnormalities.

what is amniotomy (AROM)

artificial rupture of membranes (amniotic sac) by using a sterile, sharp instrument...for the purpose of inducing or augmenting labor

fetal fibronectin test

This test looks for a protein made by the baby’s membranes.

when is fetal fibronectin test done

between 22-24 weeks

Tocolytic Therapy

Aims "to stop uterine contractions and keep the fetus in utero until the lungs are mature enough to adapt to extrauterine life

Magnesium sulfate

"drug of choice" to "protect the fetus from developing cerebral palsy."

what to monitor for after taking magnesium sulfate

toxicity and limited use (fewer than 5-7 days) due to potential fetal side effects

Terbutaline (Brethine)

stop uterine contractions within minutes given subQ

what position to place mother in during prolaped umbilical cord

knee to chest or trendelenburg

complete uterine rupture

a hole through the uterine wall, from the uterine cavity to the abdominal cavity

incomplete rupture

uterus tears into a nearby structure, such as a ligament, but not all the way into the abdominal cavity

uterine involution

changes that the reproductive organs, particularly the uterus, undergo after birth to return them to their pre-pregnancy size and condition.

Subinvolution

failure of the uterus to return to the prepregnant state after 6 weeks.

lochia rubra

red, lasts 1-3 days

lochia serosa

pinkish, blood and mucus. lasts 4-10 days

lochia alba

clear or white, lasts 11-21 days

Episiotomy

cut by dr

Lacerations

spontaneous tear

postpartum danger signs

high fever, persistent lochia rubraa, bright red bleeding, prolonged pain, uti

postpartum hemorrhage

Blood loss greater than 500 mL after vaginal birth or 1000 mL after cesarean birth, resulting in signs or symptoms of hypovolemia

Oxytocin (Pitocin) and Methylergonovine (Methergine)

stimulate contractions

newborn respiratory rate

30-60 breaths/min

newborn HR

110-160 bpm

newborn temp skin

96.8-97.7

newborn axillary temp

97.7-99.0

what does apgar score assess

Heart rate, Respiration, Muscle tone, Reflexes, Skin color.

ballard scoring system

A method used to estimate gestational age within 1-2 weeks. focuses on external characteristics and neurological development

conduction

transfer of heat to a cooler surface

convection

loss of heat ti the surrounding cooler air

radiation

loss of heat to surrounding cold enviornment

hypoglycemia in newborns

blood glucose lower than 45 mg 2 hrs after birth

signs of hypoglycemia

Jitteriness, Poor muscle tone, Respiratory difficulty, Low temperature, Poor suck, High - pitched cry, Lethargy, Seizures, Sweating

respiratory distress signs

persistent cyanoisis, grunting, flaring of nostrils, retractions under the sternum and between the ribs, respiratory rate 60+ breaths/min, HR 160+ or <110, low or high temp

molding

conforming of the fetal head to the size and shape of the birth canal. This is NORMAL

caput succedaneum

swelling of the soft tissues of the scalp. It subsides without treatment.

Cephalohematoma

collection of blood beneath the periosteum of the cranial bone. It does not cross the suture line.

fontanelles

soft spots on the cranium

anterior fontanelle

diamond shaped and closes around age 12 to 18 months; called soft spot

posterior fontanelle

triangular shaped, smaller, and closes by the end of the 2nd month

Acrocyanosis

cyanosis of the hands and feet in the first week of life. This is normal.

monogolian spots

bluish discolorations of the skin, are common in infants of African American, Native American, and Mediterranean descent. This is normal, but these should be documented to rule out abuse in future doctor’s office visits.

Jaundice and Hyperbilirubinemia

Jaundice on the "first day of life is always pathological and necessitates prompt intervention.

symptoms of jaundice

Irritability, Lethargy, Poor feeding, High-pitched shrill cry, Muscle weakness progressing to opisthotonos positioning (arched back), Seizures

Kernicterus

a toxic buildup of bilirubin in the brain, may cause brain damage or permanent disability

treatment for kernicterus

phototherapy to reduce levels. Involves placing newborn under fluorescent lights with eyes and genitals protected

Bhutani Nomogram

determine the level of risk based on the infant’s hours of age and serum bilirubin result

Moro reflex

If the crib is jarred, infants draw their legs up and the arms fan out and then come toward midline in an embrace position This is normal

Tonic neck reflex

head is turned to one side, the arm and leg are extended on the same side, and the opposite arm and leg are flexed in a “fencing” position

how many wet diapers should a newborn have per day

6

how many teaspoons should be given to a newborn getting introduced to solids

Only small amounts at first (1 teaspoon)

what does voluntary movements replace

primitive reflexes

prolactin

anterior pituitary, causes milk production

oxytocin

posterior pituitary, causes milk ejection (let-down reflex)

Transitional milk

7-10 days after birth, fewer immunoglobulins/proteins, increased lactose, fat, calories

Mature milk

14 days after birth," "Bluish color, thin, contains 20 kcal/oz and all of the nutrients the infant needs

Mastitis

An infection of the breast, occurring "2-3 weeks after birth

signs of masitis

Redness, heat in breast, Tenderness, Edema, heaviness in breast, Purulent drainage

hydrocephalus (water head, water on the brain)

Increase in cerebrospinal fluid (CSF) within ventricles of the brain," leading to "Increased pressure changes in the brain" and "Increased head size (fontanelles bulge)

signs of hydrocephalus

"Scalp is shiny" with "dilated scalp veins.

non-communicating hydrocephalus

Obstruction of CSF flow

communicating hydrocephalus

CSF inadequately reabsorbed

diagnosis huydrocephalus

"Transillumination" (flashlight test), "Daily head measurements," CT/MRI

treatment for hydrocephalus

"Ventriculoperitoneal shunt (VP shunt)" to drain excess fluid

occulta neural tube defect

Small opening, no protrusion, may have "tuft of hair, dimple, lipoma or discoloration at the site

treatment for occulta

none unless symptomatic

cystica neural tube defect

protrusion of structures

meningocele

less severe, sac that protrudes from the spine contains only the protective membranes of the spinal cord (the meninges) and cerebrospinal fluid

Meningomyelocele

protruding sac contains meninges, cerebrospinal fluid, a portion of the spinal cord and nerves.

treatment for cleft lip

chelioplasty (surgical repair) before age 6 months

infections from cleft palate

Leads to infections of the respiratory tract or middle ear (which can result in hearing loss) and speech difficulties

treatment for cleft palate

Surgery "between 1 year and 18 months of age

clubfoot

Foot is twisted inward or outward

mild musculoskeletal defects

Due to uterine position, corrects with exercises

true clubfoot requires

Splinting or casting" and possibly "Passive stretching exercises." If ineffective by 3 months, "surgery might be done.

Developmental Hip Dysplasia

Head of femur is partially or completely displaced as a result of a shallow hip socket

Treatment hip dysplasia

constant flexion and abduction for 4-8 weeks" using a "Pavlik harness by 2 months or Traction then casting in a froglike position – Spica cast

Phenylketonuria (PKU) metabolic defect

genetic disorder caused by the faulty metabolism of phenylalanine.

Diagnosis for PKU

Guthrie blood test – obtained after 48-72 hours of life, preferably after ingestion of proteins

treatment for pku

Close dietary management" to maintain phenylalanine levels

Maple Syrup Urine Disease

Defect in metabolism of branched-chain amino acids," leading to "acidosis, cerebral degeneration and death within 2 weeks if left untreated

manifestations maple syrup urine disease

Appears healthy at birth, then develops "feeding difficulties, loss of moro reflex, Hypotonia, irregular respirations, convulsions." Urine, sweat, and ear wax "smell like maple syrup.

treatment for maple syrup urine disease

EARLY DETECTION!" Hydration, peritoneal dialysis, and lifelong diet low in specific amino acids

Galactosemia

Body is unable to use carbohydrates, galactose and lactose." Can cause "cirrhosis of the liver, cataracts and mental retardation if left untreated.

erythroblastosis fetalis

Caused when an Rh-negative mother produce an Rh-positive fetus

Hydrops fetalis

Most serious form, causing "anemia, heart failure, fetal hypoxia, and anasarca (generalized edema)

hydrops fetalis diagnosis

Confirmed by amniocentesis and "Direct Coombs’ test" on cord blood

hydrops fetalis manifestations

Hyperbilirubinemia may develop due to pathological jaundice (within 24 hours of delivery)

microcephaly

congenital anomaly in which the head of the newborn is unusually small

smegma

cheese like substance secreted by the sebaceous glands near the clitoris in the female and under the prepuce of the uncircumcised male

kernicterus

grave form of jaundice in the newborn caused by hyperbillrubinemia and resulting in brain damage

erythema toxicum

splotchy red areas with firm yellow-white papules that have a red base

Cephalohematoma

swelling containing blood, found on the head of some newborns. Swelling does not cross suture lines and appears unilateral; usually disappears within a few weeks to 2 months w/o treatment

Meconium

First stool of newborn, green or black in color

Choose liquid medications over pills in children

Under 5 y/o

How to administer ear drops in children <3

Pull pinna down and back

Ear drops administration for children >3

Pull the pinna up and back

Hyadatidiform Mole

Abnormal increase in chorionic villi form fluid filled vesicle resembling tiny grapes

Placenta Previa

Painless, bright red bleeding